Gregg Stone, MD, provides the clinical trialist’s view on whether there will ever be a positive or practice-changing cardiogenic shock trial. “Yes, but the devil’s in the details,” Dr. Stone concludes. He highlights past trials and describes challenges to randomization in cardiogenic shock, including heterogeneous populations, the “I know better” attitude, procedural learning curves, and informed consent challenges. He also discusses ways to optimize the chances of successfully completing a positive randomized shock trial, which include enrolling the right population, ensuring protocol compliance, and selecting meaningful endpoints. He then highlights the DanGer SHOCK trial and RECOVER IV randomized controlled trial. Dr Stone gave this presentation at the Cardiogenic Shock Working Group (CSWG) Global Summit in 2023.